Dizziness and Unstable Gait in Old Age: Etiology, Diagnosis and Treatment

Abstract

Background: Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated.

Methods: This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo."

Results: Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training.

Conclusion: If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.

Figure

Rates of symptoms of vertigo in a specialist outpatient clinic of the German Center for Vertigo and Balance Disorders in Munich. The figure shows the relative frequencies in 500 consecutive patients aged <40 (5–39) years and >80 (81–99) years. In older patients, bilateral vestibular failure (BVF), central vertigo (CV), and benign paroxysmal positioning vertigo (BPPV) are particularly common. Further abbreviations: y, years; OC, other causes, MD, Menière’s disease; PPV, somatoform and phobic postural vertigo; UV, unilateral vestibulopathy; VM, vestibular migraine; VP, vestibular paroxysmia